For almost two years, water that came out of the taps in Flint contained elevated levels of lead. Residents complained about the taste and smell of the water after the city switched from Lake Huron water treated by the Detroit Water and Sewerage Department to Flint River water treated by the city in April 2014, but state officials dismissed their concerns.

It wasn’t until after Dr. Mona Hanna-Attisha, a pediatrician at Hurley Medical Center and assistant professor at Michigan State University, sounded the alarm about lead poisoning in Flint children that local officials warned residents to stop drinking the water on Oct. 1, 2015.

As the city grapples with a public health emergency, children are of particular concern. Those under age 6 are especially vulnerable to lead poisoning because their nervous systems are still developing and because their body mass is so small, they ingest more lead per pound than adults. The presence of lead can affect the brain and nervous system, and potentially cause serious and largely irreversible damage even at low levels of exposure. The results in children can include development delays, learning difficulties, irritability, weight loss and hearing loss.

Babies who are exposed to lead in the womb may also suffer from slowed growth and learning difficulties. Adults who are exposed may have high blood pressure, joint and muscle pain, headache, memory loss and mood disorders. Miscarriages or premature births are possible in pregnant women.

Doctors use a simple blood test to detect lead poisoning. There is no safe level of lead in the blood

Parents in Flint are concerned, says Hanna-Attisha, also known as Dr. Mona. Here, she answers questions about what Flint children face now and in the future and the steps their parents can take to protect them.

Q: Will all children be affected in the same way?

A: Absolutely not. And many children we hope will have nothing wrong with them. We are actively reassuring our families that not all children are going to have all these problems. What we’re not going to do is wait and see. We’re going to wrap these children and families around with interventions so we don’t see these consequences. We ‘re actively telling families things they can do to bolster their development chances … We’re trying to give families hope.

Q: How long before symptoms are likely to show up?

A: It depends. Every kid will present differently. Some kids there are concerns now, and some symptoms we’ll see later. We’ll never know if the cause was lead because you can’t ever pinpoint it. In large-scale studies, this is what lead does: It impacts your cognition, your behavior. You can’t do a specific test. Symptoms typically appear when a child starts school.

Q: What are the long-term consequences for children who are exposed to lead?

A: The main impact is on cognition and behavior, which will manifest usually as school problems — problems concentrating, problems focusing, comprehension and behavioral issues.

Q: Is there anything that pregnant women can do to protect their unborn babies?

A: Absolutely do not drink the water. Please use extra precautions for ... pregnant women and babies on formula ... use bottled water for those populations. They’re the most vulnerable. (Pregnant women also) need to take their prenatal vitamins, and they need to make sure they don’t have empty stomachs (because the body absorbs lead easier on an empty stomach) and they have healthy foods. Eat well and often. And be sure to go to your OB (obstetrician).

Q: A diet high in calcium, iron and Vitamin C can limit the effects of exposure to lead. Recommended foods include milk and milk products such as yogurt and cheese; green leafy vegetables such as spinach and collard greens; lean red meats, chicken or fish; iron-fortified cereals; dried fruits such as raisins; citrus fruits such as oranges, and tomatoes, strawberries and melons. Do you have any other dietary tips?

A: Lead-mitigating diets are important now during this recent and ongoing exposure ... In the long term, nutrition plays a tremendous role in promoting child brain development. (She noted parents can attend weekly healthy cooking demonstrations at the Farmers’ Market at Hurley Medical Center, 1 Hurley Plaza, and can learn more at www.hurleymc.com/wellness/lead-resources or by calling 844-935-5463.)

Q: Is it safe to cook with tap water as long as the home has an approved filter?

A: Yes. You must use a filter or bottled water for cooking. Cooking concentrates lead in your food. If you’re using tap water, especially hot water, you’re going to get a lot of lead in that water.

Q: What kind of water should parents use to make formula?

A: Bottled water. Premixed formula, called ready-to-feed, is available through WIC. (The reference is to the Special Supplemental Nutrition Program for Women, Infants, and Children. WIC supplies extra food for low-income pregnant or breastfeeding mothers, infants and young children. To apply for WIC, call 800-262-4784 or 810-237-4537).

Q: Celebrity donors have pledged a million bottles of water with electrolytes. Should parents use this water to prepare baby formula?\

A: No. They should use (regular) bottled water ... Babies can be really sensitive to too much or too little electrolytes. What’s in the formula is the composition of electrolytes that babies need.

Q: Is it safe to breast feed after drinking Flint water?

A: If a mom is concerned she should check with her OB and get her blood tested for lead. Breast feeding is much better than unfiltered tap water and formula.

Q: How is lead stored in the body?

A: Once the lead comes into your body it is either excreted in your urine or it is stored in your bones.

Q: What can cause lead to leave your bones and get back into the bloodstream, and what does that do to your system?

A: It can cause neurotoxicity over again. Whenever someone is under stress, has poor nutrition or is pregnant, it can leave the bones and cause impacts.

Q: Are there any particular concerns about other vulnerable populations, such as the elderly or those with chronic diseases?

A: Yes, lead impacts everybody, and it impacts every single organ system.

Q: How do you recommend parents bathe their children? Is a quick shower with tap water safe?

A: If their only concern is lead in the water, bathing is not an issue. It does not go through your skin.

Quick showers are fine. However, there are a lot of other concerns about the water. First there was a lot of bacteria in the water, which might have caused some of the rashes and skin irritation. Then to take care of the bacteria, there was a lot of chlorine added to the water, which irritated people’s skin and eyes. We’re seeing skin issues that we’re managing on a case-by-case basis. The state is now actively tracking all the rashes that are being seen and looking at the water more closely to see if there’s anything else in the water that may be irritating skin. They’re actively looking into it, the state and the CDC (federal Centers for Disease Control and Prevention), including creating a database and looking at the water for all kinds of things.

Q: What can people do about these rashes?

A: If you bathe your baby and the baby gets a rash, use bottled water, filtered water. It’s something we’re looking at closely and trying to manage.

Q: Why are regular checkups with a child’s doctor so important?

A: Every time we see a child, we check their development. The sooner we identify a concern, the sooner we can get the child the necessary resources and the better their outcome. In addition, your doctor will provide additional education on nutrition and all the other interventions that will support the child’s development. This is a long-term issue that needs long-term follow-up and there’s nobody better than the child’s regular physician.

Q: Do you recommend that children in Flint be tested for lead?

A: If anybody has any concerns about the level of lead in their blood, they should get their blood tested. Testing only reflects recent or ongoing exposure, so if a family had been drinking the water until just recently, and they’re concerned, they should get tested. Testing does not reflect past exposure. It doesn’t tell you what your lead level was a year ago because lead has a half-life of 20 to 30 days. That is why all the interventions are needed for all children. Even if they don’t have an elevated lead level now, it doesn’t mean it wasn’t elevated a year ago. Lead only lasts a short period in your blood.

Q: In addition to water, lead can also be found in soil, household dust and paint chips. Washing hands and toys can reduce hand-to-mouth transfer of contaminated dust or soil. What other measures can parents can take?

A: Kids are most at risk for these household exposures around the ages of 1 and 2, which is why we (doctors) screen at ages at 1 or 2. They’re crawling around, grab a chip of paint from a wall and put it in their mouth. They have a lot of hand-to-mouth activity. Families need to make sure that these exposures are not in their house. Frequent vacuuming, dusting of window sills, wet mopping limit the exposure. And make sure the kids wash their hands before they eat.

Q: What else should parents do?

A: The most important thing that families can do to support their children’s development is is to be there. Kids need a supportive caregiver in their lives. If they’re scared, having trouble coping, they need to be able to turn to somebody. There’s so much evidence that having that stable, supportive caregiver in a child’s life builds resilience in children.

Q: Why is getting children into preschool so important?

A: The benefits of early education are well-known. Preschool supports brain development, enables kids to be ready for school, to be ready to learn, and it supplies two-thirds of their nutrition during the day. ... The 0 to age 5 is critical, kids need routines as much as possible, and being in preschool is part of that.

Q: As part of your continuing research into this city-wide exposure to elevated levels of lead, why are you looking at miscarriage rates and low-birth-weight babies?

A: Lead exposure has maternal-fetal implications and it’s been known to cause miscarriages, low-birth-weight babies. We are conducting research, to see if we had higher rates during this water period.

Q: You’re going to collect children’s baby teeth as they lose them over the next five years. What will teeth to tell you?

A: Teeth are like tree rings. You can see if the kid was lead-exposed, how much lead exposure there was, and when the kid had it. We’re also looking at newborn heel spots (the blood taken in hospitals from the heels of all newborn babies) because lead in water impacts newborns. We’re going to get lead levels from those heel spots.

Q: You direct the MSU-Hurley Pediatric Public Health Initiative, which is dealing with the fallout of the Flint water crisis. What immediate steps is the group taking to deal with health issues from lead and other contaminants found in Flint’s drinking water?

A: Our work is to actively promote and implement interventions that will lessen the impact of the exposure. ... We want to flip this story so that the nation can see that Flint had this disaster. But we brought in this team of experts, working with the community, and working with government, to intervene. Because we cannot sit back and research these kids in 20 years and see the consequences. ... We are focusing on all children under age 6, about 9,000-10,000 kids. ... We may expand to adults and even animals, because animals are often predictors, dogs are often sentinels of human diseases and outcomes.

Q: Last thoughts?

A: Not every kid will have every problem. There are things parents can actively do now to prevent future problems. The water is still not safe. Use filters. Do go to your doctor for long-term follow-up. Be there for your child. Love them. Read to them. Sing to them. Turn off the TV. Do everything you would be doing anyway to support your child’s development. We’re hopeful with the interventions we can bring to the community that our children will have a brighter tomorrow than they had yesterday. They already had so many obstacles to their success.